新辅助 PD-1/PD-L1 抑制剂联合化疗在未经治疗的头颈部鳞状细胞癌（HNSCC）中的 ORR 高于单免疫治疗：荟萃分析。
Neoadjuvant PD-1/PD-L1 inhibitors combined with chemotherapy had a higher ORR than mono-immunotherapy in untreated HNSCC: Meta-analysis.
机构信息
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
出版信息
Oral Oncol. 2023 Oct;145:106479. doi: 10.1016/j.oraloncology.2023.106479. Epub 2023 Jul 19.
BACKGROUND
HNSCC is one of the most common types of cancer worldwide and immune checkpoint inhibitor has shown favorable therapeutic effect in R/M HNSC. However, the application of immunotherapy in untreated HNSCC still needs to be discovered since most R/M HNSCC patients have been treated before and their drug susceptibility and immune tumor microenvironment have changed. This meta-analysis tries to compare immunotherapy and immunochemotherapy in untreated HNSCC and give a reference for clinic application.
METHODS
Electronic databases, including PubMed, Embase, and Web of Science, were systematically searched from inception through August 31, 2022. The primary outcomes were efficacy, evaluated by objective response rate, 1-year OS and 1-year PFS, and safety, evaluated by grade 3-4 adverse reaction rate.
RESULTS
A total of 1092 patients from twenty-four studies were included, 282 (25.8%) of which had ORR reported. The average ORR was 37% (95%CI = 26%-49%). Immunochemotherapy could have higher ORR than immunotherapy patients (ORR: 61% vs 22%), and favorable 1-year overall survival from PD-L1 inhibitor (OS = 84%, 95%CI 76%-93%). Radiotherapy after neoadjuvant immunotherapy was equal with the other treatments like chemotherapy and surgery (84% vs 88%, subgroup df p = 0.7). There was no apparent difference between immunotherapy and immunochemotherapy (32% vs 42%, subgroup df p = 0.60).
CONCLUSION
HNSCC patients could benefit more from neoadjuvant immunochemotherapy.
背景
HNSCC 是全球最常见的癌症类型之一，免疫检查点抑制剂在 R/M HNSCC 中显示出良好的治疗效果。然而，由于大多数 R/M HNSCC 患者之前已经接受过治疗，其药物敏感性和免疫肿瘤微环境已经发生变化，因此仍需要探索免疫疗法在未经治疗的 HNSCC 中的应用。本荟萃分析旨在比较免疫治疗和免疫化疗在未经治疗的 HNSCC 中的疗效，并为临床应用提供参考。
方法
系统检索了 PubMed、Embase 和 Web of Science 等电子数据库，检索时间从建库至 2022 年 8 月 31 日。主要结局指标为客观缓解率（ORR）、1 年总生存率（OS）和 1 年无进展生存率（PFS），安全性评估为 3-4 级不良反应发生率。
结果
共纳入 24 项研究的 1092 例患者，其中 282 例（25.8%）患者报告了 ORR。ORR 的平均水平为 37%（95%CI=26%-49%）。免疫化疗组的 ORR 高于免疫治疗组（ORR：61% vs 22%），PD-L1 抑制剂的 1 年总生存率（OS=84%，95%CI 76%-93%）也更好。新辅助免疫治疗后行放疗与化疗和手术等其他治疗方法的疗效相当（OS=84% vs 88%，亚组 df p=0.7）。免疫治疗与免疫化疗之间无明显差异（32% vs 42%，亚组 df p=0.60）。
结论
新辅助免疫化疗可使 HNSCC 患者获益更多。
Zotero 插件